|The 2015 Collaborative Family Healthcare Association’s Policy Summit, “Nurturing the forest as well as each tree: The Role of Collaborative, Integrated Care in Advancing Population Health” was held in conjunction with CFHA’s 17th Annual conference in Portland, Oregon. The panel for this summit included experts from both the public and private sectors in Oregon and Colorado. This meeting was the first of its kind for CFHA, covering current initiatives and barriers, stories of success, and future challenges regarding the unique process of healthcare change.
The format of this year’s summit meeting was conversational and intimately set, enabling panel members to enjoy a sense of safety as they discussed mutual challenges with only a small sympathetic audience within earshot. Two factors were clear at the onset of the meeting:
1.) both Oregon and Colorado have had tumultuous histories with healthcare reform and
2.) both states have taken advantage of recent crises to try new and bold initiatives.
|For example, in 2010 Oregon faced financial problems in supporting state health services. In response, state legislature approved (57 to 3) plans to create Coordinated Care Organizations (CCO) to “treat the whole person: and organize previously fragmented services for the Medicaid population. In Colorado, several factors lead to innovation including fallout from years of managed care, state fiscal issues, and the indomitable Colorado spirit of independence. State leaders began to invest in a new multi-player system and integrated behavioral health services. Today, both states are finding success with their recent investments in groundbreaking policy strategies as well as facing ongoing, inherent challenges.
Some of those challenges include:
-Working with federal, state, and local stakeholders: allowing for flexibility while striving for standardization in policies and protocols
-Creating a clearinghouse for data management and sharing
-Federal administrators have short tenures which disrupts momentum and working relationships
-States are not collaborating enough to share successes and brainstorm new strategies
-Fear and misconceptions of change and the health care industry prevent stakeholders from making progress
-Moving customers from Medicaid to private insurance
|Despite these challenges, both states have made remarkable progress. Colorado boasts one of the lowest uninsured rates in the country, has multiple integrated care clinics across the state, and utilizes an effective multi-player model. Oregon has 16 CCOs across all parts of the state to cover over 2 million Medicaid recipients, is moving away from volume-based to outcome-based productivity models, and is working closely with counties across the state toward a global budget.
|All panel members agree that there Is much more to be done. Ron Stock believes that states should be as transparent as possible when reporting outcomes of various quality metrics. He also notes that a more cohesive and comprehensive advocacy plan will carry the message of reform farther. Patrick Gordon reminded the audience that hospital systems need reform as well to completely move away from the fee-for-service model of yesteryear. Robin Henderson predicts that success with reforming the Medicaid systems will lead to future success in improving state employee health systems. Finally, Sean Kolmer believes that state governments can drive the conversation on integrated health care services and that state budget crises are real opportunities for designing innovative policies that take health care systems in new directions.
-Senator Elizabeth Steiner Hayward, MD, Oregon State Senator, Family Physician
-Janet Mayer, MHA, CEO at Health Share of Oregon
-Ron Stock, MD, MA, Director of Clinical Innovation, Oregon Health Authority
-Sean Kolmer, MPH, Principal, Health Management Associates
-Lynne Saxton, Director, Oregon Health Authority
-Robin Henderson, PsyD, Chief Behavioral Health Officer/Vice President of Strategic Integration
-Patrick Fox, MD, Chief Medical Officer, Colorado Department of Human Services
-Patrick Gordon, MPA, Associate VP Rocky Mountain Health Plans
-Judy Zerzan, MD, MPH, Chief Medical Officer/Director of Client & Clinical Care Office
Colorado Department of Health Care Policy and Financing
-Vatsala Pathy, Director, State Innovation Model
-Deborah Cohen, PhD Associate Professor
Department of Family Medicine at Oregon Health & Science University